Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks
Abstract Background Aquaporin-4 immunoglobulin G Neuro Myelitis Optica spectrum disorders attacks (NMOSD-AQP4-IgG+ attacks) can cause respiratory failure requiring orotracheal intubation (OTI), but the risk factors and outcomes of OTI during attacks remain unclear. Our primary objective was to ident...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2024-01-01
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| Series: | Annals of Intensive Care |
| Online Access: | https://doi.org/10.1186/s13613-023-01213-x |
| _version_ | 1797355484122972160 |
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| author | Edouard Januel Vincent Brochard Loïc Le Guennec Elisabeth Maillart Céline Louapre Catherine Lubetzki Nicolas Weiss Sophie Demeret Caroline Papeix |
| author_facet | Edouard Januel Vincent Brochard Loïc Le Guennec Elisabeth Maillart Céline Louapre Catherine Lubetzki Nicolas Weiss Sophie Demeret Caroline Papeix |
| author_sort | Edouard Januel |
| collection | DOAJ |
| description | Abstract Background Aquaporin-4 immunoglobulin G Neuro Myelitis Optica spectrum disorders attacks (NMOSD-AQP4-IgG+ attacks) can cause respiratory failure requiring orotracheal intubation (OTI), but the risk factors and outcomes of OTI during attacks remain unclear. Our primary objective was to identify the clinical and radiological risk factors for OTI in NMOSD-AQP4-IgG+ attacks. As a secondary objective, we aimed to evaluate the prognosis of OTI-attacks. Methods We retrospectively analyzed NMOSD-AQP4-IgG+ attacks at the Pitié-Salpêtrière Hospital (Jan 2010–Jan 2021), excluding isolated optic neuritis. The primary outcome was the need for OTI due to neurological dysfunction an attack (OTI-attack). The secondary outcome was attack’s poor recovery after 12 months, defined as a modified Rankin score (mRS) > 2 in patients with an initial mRS ≤ 2, or an increase ≥ 1 point in mRS in other patients. Analyses were performed using a binomial generalized linear mixed model, with a random intercept for the patient ID to account for within-patient correlations. Results Seventy-three attacks in 44 patients NMOSD-AQP4-IgG+ were analyzed. Of 73 attacks, 8 (11%) required OTI during the attack, related to acute restrictive respiratory failure (n = 7) and/or severe swallowing disorder (n = 2). None of the OTI-attacks occurred in patients previously treated with active disease-modifying treatment (DMT), while 36 (55.4%) of the non-OTI-attacks occurred in patients who were already on active DMT. On admission, OTI-attacks were more likely to have upper limbs motor paresis of (75.0% versus 29.2%, p = 0.366) and dyspnea (3 [50.0%] versus 4 [6.6%], p = 0.002) compared to non-OTI-attacks. MRI analysis showed that OTI-attacks had edematous lesions in the cervical spinal cord, mainly at levels C1 (75% versus 0% in non-OTI-attacks), C2 (75% versus 1.9%), C3 (62.5% versus 1.9%), and C4 and C5 levels (50% versus to 3.9%). One OTI-attack resulted in the death of one patient. Five patients with OTI-attack had mRS ≤ 2 one year after OTI-attack. Two (25%) OTI-attacks had poor recovery compared to 15 (24.2%) non-OTI-attacks (p = 0.468). Conclusion OTI-attacks occurred in untreated NMOSD-AQP4-IgG+ patients and were associated with edematous upper cervical lesions. The prognosis of these attacks may be favorable, and warrant maximal medical and supportive treatment. Trial registration This was a retrospective observational monocentric cohort study nested in the NOMADMUS cohort (ClinicalTrials.gov Identifier: NCT02850705) Graphical Abstract |
| first_indexed | 2024-03-08T14:11:49Z |
| format | Article |
| id | doaj.art-09b8e93bae6e491080f5824178005eef |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-08T14:11:49Z |
| publishDate | 2024-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-09b8e93bae6e491080f5824178005eef2024-01-14T12:36:18ZengSpringerOpenAnnals of Intensive Care2110-58202024-01-0114111110.1186/s13613-023-01213-xRisk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacksEdouard Januel0Vincent Brochard1Loïc Le Guennec2Elisabeth Maillart3Céline Louapre4Catherine Lubetzki5Nicolas Weiss6Sophie Demeret7Caroline Papeix8Neurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPNeurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPunité de Médecine Intensive Réanimation à orientation Neurologique, Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéNeurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPNeurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPNeurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPunité de Médecine Intensive Réanimation à orientation Neurologique, Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne Universitéunité de Médecine Intensive Réanimation à orientation Neurologique, Département de Neurologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéNeurology Department, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Pitié-Salpêtrière University Hospital, AP-HPAbstract Background Aquaporin-4 immunoglobulin G Neuro Myelitis Optica spectrum disorders attacks (NMOSD-AQP4-IgG+ attacks) can cause respiratory failure requiring orotracheal intubation (OTI), but the risk factors and outcomes of OTI during attacks remain unclear. Our primary objective was to identify the clinical and radiological risk factors for OTI in NMOSD-AQP4-IgG+ attacks. As a secondary objective, we aimed to evaluate the prognosis of OTI-attacks. Methods We retrospectively analyzed NMOSD-AQP4-IgG+ attacks at the Pitié-Salpêtrière Hospital (Jan 2010–Jan 2021), excluding isolated optic neuritis. The primary outcome was the need for OTI due to neurological dysfunction an attack (OTI-attack). The secondary outcome was attack’s poor recovery after 12 months, defined as a modified Rankin score (mRS) > 2 in patients with an initial mRS ≤ 2, or an increase ≥ 1 point in mRS in other patients. Analyses were performed using a binomial generalized linear mixed model, with a random intercept for the patient ID to account for within-patient correlations. Results Seventy-three attacks in 44 patients NMOSD-AQP4-IgG+ were analyzed. Of 73 attacks, 8 (11%) required OTI during the attack, related to acute restrictive respiratory failure (n = 7) and/or severe swallowing disorder (n = 2). None of the OTI-attacks occurred in patients previously treated with active disease-modifying treatment (DMT), while 36 (55.4%) of the non-OTI-attacks occurred in patients who were already on active DMT. On admission, OTI-attacks were more likely to have upper limbs motor paresis of (75.0% versus 29.2%, p = 0.366) and dyspnea (3 [50.0%] versus 4 [6.6%], p = 0.002) compared to non-OTI-attacks. MRI analysis showed that OTI-attacks had edematous lesions in the cervical spinal cord, mainly at levels C1 (75% versus 0% in non-OTI-attacks), C2 (75% versus 1.9%), C3 (62.5% versus 1.9%), and C4 and C5 levels (50% versus to 3.9%). One OTI-attack resulted in the death of one patient. Five patients with OTI-attack had mRS ≤ 2 one year after OTI-attack. Two (25%) OTI-attacks had poor recovery compared to 15 (24.2%) non-OTI-attacks (p = 0.468). Conclusion OTI-attacks occurred in untreated NMOSD-AQP4-IgG+ patients and were associated with edematous upper cervical lesions. The prognosis of these attacks may be favorable, and warrant maximal medical and supportive treatment. Trial registration This was a retrospective observational monocentric cohort study nested in the NOMADMUS cohort (ClinicalTrials.gov Identifier: NCT02850705) Graphical Abstracthttps://doi.org/10.1186/s13613-023-01213-x |
| spellingShingle | Edouard Januel Vincent Brochard Loïc Le Guennec Elisabeth Maillart Céline Louapre Catherine Lubetzki Nicolas Weiss Sophie Demeret Caroline Papeix Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks Annals of Intensive Care |
| title | Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks |
| title_full | Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks |
| title_fullStr | Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks |
| title_full_unstemmed | Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks |
| title_short | Risk factors and prognosis of orotracheal intubation in aquaporin-4-IgG neuromyelitis optica spectrum disorder attacks |
| title_sort | risk factors and prognosis of orotracheal intubation in aquaporin 4 igg neuromyelitis optica spectrum disorder attacks |
| url | https://doi.org/10.1186/s13613-023-01213-x |
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